1669408936 NPI number — DR. HENRY JAY ZWALLY II MD

Table of content: DR. HENRY JAY ZWALLY II MD (NPI 1669408936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669408936 NPI number — DR. HENRY JAY ZWALLY II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZWALLY
Provider First Name:
HENRY
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZWALLY
Provider Other First Name:
H.
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669408936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20010 CENTURY BLVD.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-780-7899
Provider Business Mailing Address Fax Number:
240-780-7899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7116 RITCHIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-577-0277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  D0042684 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064940600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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